Term
| Asthma that is the most severe usually shows up when? |
|
Definition
|
|
Term
| What are the 2 types of asthma? |
|
Definition
Allergic Asthma
Non-allergic Asthmas
(exercise induced, chemically induced) |
|
|
Term
| What kind of meters should asthmatics be given for home use? |
|
Definition
| Peak expiratory flow meters |
|
|
Term
| What are the goals of asthma management? |
|
Definition
1. correct hypoxemia
2. quickly reverse airflow obstruction
3. treat the underlying inflammatory response
4. prevent recurrences |
|
|
Term
| Asthma medications fall into what 2 general classes? |
|
Definition
1. long-term control medications
2. quick relief medications |
|
|
Term
| Long-term medications are used... |
|
Definition
| daily to achieve and maintain control of persistent asthma |
|
|
Term
| The most effective long-term asthma medications are those that reduce what? |
|
Definition
| the underlying inflammation |
|
|
Term
| List the long-term asthma medications. |
|
Definition
corticosteroids
mast cell stabilizers
immunomodulators
leukotriene modifiers
long acting Beta adrenergic agonists
methylxanthines |
|
|
Term
| Quick-relief asthma medications are used to treat... |
|
Definition
| acute symptoms and exacerbations |
|
|
Term
| List the quick-relief asthma medications. |
|
Definition
short-acting beta adrenergics
systemic corticosteroids
anticholinergics |
|
|
Term
| Which asthma drugs are short acting beta 2 selective agents? |
|
Definition
Albuterol
Terbutaline
Pirbuterol
Levalbuterol
Metaproterenol |
|
|
Term
| Beta adrenergic agonists have no __________________ effects and should not be used as sole agents in a person who has chronic asthma. |
|
Definition
|
|
Term
| List the long-acting Beta-2 agonists. |
|
Definition
|
|
Term
| Salmeterol and Formoterol as analogs of _____________ that have a lipophilic side chain which increases their ________. |
|
Definition
|
|
Term
| ___________________ are not routinely a part of asthma treatment. |
|
Definition
|
|
Term
| Short acting adrenergic agonists have a quick onset of action and a DOA of _______. They are used for ______________________ asthma. |
|
Definition
~6 hrs
mild and intermediate asthma |
|
|
Term
| Inhaled ________ are the mainstay of therapy for both exacerbation and maintenance of asthma. |
|
Definition
|
|
Term
| Beta 2 agonists relax ______________ and also seem to increase _______ content in bronchial mucous to promote mucociliary clearance. (MOA) |
|
Definition
bronchial smooth muscle
water |
|
|
Term
| How are beta 2 agonists administered when used for asthma? |
|
Definition
| via nubulizer or metered-dose inhaler with or without a spacer device |
|
|
Term
| How often do you administer a nebulizer in a moderate to severe exacerbation? |
|
Definition
| every 15-20 minutes -- decreasing as needed to a usual q4h interval |
|
|
Term
| How many puffs of a metered dose inhaler do you use to treat an acute exacerbation? |
|
Definition
|
|
Term
| What is levalbuterol and what advantages does it have? |
|
Definition
its an R isomer of albuterol
fewer side effects; perhaps better bronchodilation |
|
|
Term
| You should never use ____________ for an acute exacerbation of asthma. |
|
Definition
| long acting beta-2 agents |
|
|
Term
| Salmeterol should only be used if the patient is also using ____________________. |
|
Definition
|
|
Term
| Salmeterol has a ______ onset and its good to use prior to _______________. |
|
Definition
|
|
Term
| Patients with severe exacerbations or those who fail to respond to standard therapy may require more intensive therapy with ________________________. |
|
Definition
|
|
Term
| What are your 2 options for systemic beta-2 agents? |
|
Definition
| SQ or IV epinephrine or terbutaline |
|
|
Term
| Epinephrine and terbutaline are particularly useful when... |
|
Definition
| airway obstruction is so severe that inhaled agents cannot effectively reach the distal airways. |
|
|
Term
| Is terbutaline or epinephrine preferrable? why? |
|
Definition
| terbutaline, bc it can be administered as a continuous infusion (but the child should be in the ICU for contiuous monitoring) |
|
|
Term
| List the SEs of oral albuterol, metoproterenol, and terbutaline. |
|
Definition
tachycardia
tremors
hyperglycemia
dysrhythmias |
|
|
Term
| Theophylline is a ______________, like caffeine. |
|
Definition
|
|
Term
| Theophylline produce bronchodilation by inhibiting __________________. It also has some __________________ actions. |
|
Definition
phosphiesterase
anti-inflammatory |
|
|
Term
| How is theophylline administered? |
|
Definition
|
|
Term
| What is the HL of theophylline? |
|
Definition
~8 hours in adult/nonsmokers
4 hours in smokers and children |
|
|
Term
| _____________ increases serum levels of theophylline. |
|
Definition
|
|
Term
| _____________ and _____________ decrease the clearance of theophylline. |
|
Definition
| macrolides and fluroquinolines |
|
|
Term
| List the AEs of theophylline. |
|
Definition
GI distress
CNS stimulation - HA, anxiety, nervousness, insomnia, (and with high doses seizures)
Cardiovascular, PVCs
Dysrhythmias at high doses |
|
|
Term
| Make sure you tell your patients to take theophylline with ________. |
|
Definition
|
|
Term
| Theophylline is metabolized by... |
|
Definition
|
|
Term
| Theophylline is used more in patients with __________ than asthma. |
|
Definition
|
|
Term
| You would use Aminophylline/Theophylline in patients with ____________________ asthma. |
|
Definition
|
|
Term
| Theophylline is not recommended routinely for use in _______________ treatment of asthma. |
|
Definition
|
|
Term
| Why must you monitor serum levels of theophylline? |
|
Definition
| because it has a narrow margin of safety |
|
|
Term
| Name the inhaled antimuscarinics. |
|
Definition
|
|
Term
| Inhaled antimuscarinics inhibit ACh-mediated ____________________ and less _________ production. (MOA) |
|
Definition
bronchoconstriction
mucus |
|
|
Term
| Why do inhaled antimuscarinics have minimal side effects? |
|
Definition
| because they are not systemically absorbed |
|
|
Term
| How long does it take Iprotropium to reach its peak effectiveness? |
|
Definition
|
|
Term
| Studies have shown that Ipratropium is helpful when coadministered with ________________ in moderate to severe exacerbations. |
|
Definition
|
|
Term
|
Definition
| a combination of Iprotropium/Albuterol |
|
|
Term
| Which rare SE might Ipratropium have? |
|
Definition
|
|
Term
| Ipratropium should be use in caution in patients with: |
|
Definition
glaucoma
prostate hypertrophy |
|
|
Term
| Corticosteroids diminish airway ______________ and _____________ and they potentiate the bronchodilating effect of _________________. |
|
Definition
inflammation and obstruction
best-2 agonists |
|
|
Term
| Who should always receive corticosteroids for asthma? |
|
Definition
| children with moderate to severe exacerbations and to those who do not completely resolve their symptoms after a single beta-2 agonist treatment. |
|
|
Term
| List the inhaled corticosteroids. |
|
Definition
Beclomethasone dipropionate
Flunisolide
Fluticasone propionate
Budesonide
Triamcinolone |
|
|
Term
| Inhaled corticosteroids are not useful in treating what aspect of asthma? |
|
Definition
| emergency treatment of asthma exacerbations |
|
|
Term
| Inhaled corticosteroids clearly decrease the risk of what among children with asthma? |
|
Definition
| hospitalization and ED visits |
|
|
Term
| If you give corticosteroids to someone with moderate to severe exacerbations it should be administered how? |
|
Definition
|
|
Term
| Which systemic steroids are used for severe asthma exacerbations? |
|
Definition
oral prednisone and prednisolone
IV methylprednisolone |
|
|
Term
| List the SEs of inhaled corticosteroids used for asthma. |
|
Definition
dysphonia
oral and esophageal candidiasis
glaucoma
cataracts |
|
|
Term
| Leukotriene modifiers are used in the management of ... |
|
Definition
| chronic asthma, outpatient |
|
|
Term
| Leukotriene modifiers interrupt the leukotriene pathway in which 2 ways... |
|
Definition
1. inhibition of 5-lipoxygenase
2. inhibition of the binding of leukotrienes to their receptors, thereby preventing their actions |
|
|
Term
| Leukotriene modifiers produce some _____________ and some ____________. |
|
Definition
bronchodilation
anti-inflammatory activity |
|
|
Term
| List the leukotriene modifiers. |
|
Definition
Zafirlukast
Montelukast - singulair**
(both block leukotriene binding)
Zileuton - inhibits 5-lipoxygenase |
|
|
Term
| Leukotriene modifiers block productions of leukotrienes that cause: |
|
Definition
bronchoconstriction
edema and
increased mucous production. |
|
|
Term
| Patients using leukotriene modifiers as adjuncts to asthma therapy may be able to decrease or stop the use of what other drug? |
|
Definition
|
|
Term
| Leukotriene modifiers are almost equally effective in reducing the frequency of exacerbations as _________________, but their effects on symptoms are less marked. |
|
Definition
|
|
Term
| Leukotriene modifiers play a role in the treatment of __________-induced asthma. |
|
Definition
|
|
Term
| How are leukotriene modifiers administered? |
|
Definition
|
|
Term
| Which Leukotriene modifiers are metabolized by P450 and highly protein bound and which aren't? |
|
Definition
Montelukast and Zafirlukast are
Zileuton is not (but it does inhibit some of the P450 enzymes) |
|
|
Term
| What are some problems associated with Zileuton? |
|
Definition
elevated LFTs
Dyspepsia
inhibits metabolism of theophylline and warfarin |
|
|
Term
| what are the advantages of leukotriene modifiers? |
|
Definition
1. fewer days of symptoms
2. fewer exacerbations
3. less steroid use
4. better quality of life |
|
|
Term
| Which leukotriene modifier is the only one approved for use in children? |
|
Definition
|
|
Term
| Mast Cell stabilizers stabilize the membrane of mast cells and prevent release of ____________. (MOA) |
|
Definition
| histamine and other autocoids |
|
|
Term
| List the Mast Cell Stabilizers. |
|
Definition
Cromolyn Sodium
Nedocromil |
|
|
Term
| Mast cell stabilizers are administered... |
|
Definition
| only by inhalation thus little systemic absorption |
|
|
Term
| Mast cell stabilizers have no use in... |
|
Definition
|
|
Term
| Which age group are mast cell stabilizers used in most? |
|
Definition
|
|
Term
| Mast cell stabilizers are best administered after... |
|
Definition
|
|
Term
| What SEs might mast cell stabilizers cause? |
|
Definition
irritated throat
cause cough and
bronchospasm |
|
|
Term
|
Definition
|
|
Term
| How is Omalizumab used in the treatment of asthma? |
|
Definition
| its an adjuntive therapy for patients 12+ years who have ALLERGIC asthma and who require step 5 or 6 care (severe persistent asthma) |
|
|
Term
| Why is Omalizumab use not very common? |
|
Definition
due to a lack of sufficient information for long term effectiveness, expense, requirements for admin and questions regarding long term suppression of IgE
Also its crazy expensive. |
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